Introduction There are conflicting perspectives as to whether antidepressant medication increases, decreases or has no effect on violence perpetration, impulsivity and aggressive behaviour. This is an important question given the widespread use of antidepressant medication and the significant medical, social, legal and health consequences of violence. We aim to: (1) systematically identify observational studies and randomised controlled trials that quantify the relationship between antidepressant use and interpersonal violence; (2) assess the quality of studies that quantify the relationship between antidepressant use and interpersonal violence and (3) estimate the pooled prevalence and measure of effect for the relationship between antidepressant use and interpersonal violence.
Methods and analysis We will search MEDLINE, EMBASE, CINAHL, PsycINFO, PubMed and the Cochrane Library for relevant peer-reviewed literature. Our primary outcome is the perpetration of violent acts directed at others. Our secondary outcome is physical, interpersonal aggression measured through validated surveys. We will include randomised controlled trials, cohort studies and case–control studies that examine the association between the use of antidepressants and violence perpetration and/or physical aggression. No restrictions will be placed on the population. We will use the Methodological Standard for Epidemiological Research scale to assess the quality of included studies. We will provide an overview of the included studies and assess heterogeneity and publication bias. If there are sufficient studies, we will conduct meta-analyses to examine the possible association between antidepressants and violence, and undertake meta-regression to examine the effect of antidepressant class, length of follow-up, age of participants and population subgroups on the association between antidepressants and violence.
Ethics and dissemination No ethics approval is required. Our findings will be disseminated through a peer-reviewed journal article and conference presentations.
PROSPERO registration details CRD42020175474.
- public health
- depression & mood disorders
- clinical pharmacology
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Contributors CK and JY developed the original research proposal. CK, JY, JAF, GN-H, MW, SF and JK contributed to the design of the project. CK and MW developed the search strategy with input from JY, JAF, GN-H, MW and JK. CK wrote the initial draft manuscript and JY, JAF, GN-H, MW, SF, RB, JK and SAK contributed significantly to drafting and editing the manuscript. All authors approved the final manuscript.
Funding JY receives salary and research support from a National Health and Medical Research Council Investigator Grant (NTG1178027). SAK receives salary and research support from a National Health and Medical Research Council Senior Research Fellowship (GNT1078168). Apart from the funding sources acknowledged above, this research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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